Hospitals decontamination

Significant accomplishments to date include the installation of decontamination capabilities at each of the 12 hospitals, decontamination and hazardous material overview training, drug and treatment reference cards for nuclear, biological, and chemical agents for both hospital and prehospital care providers, purchase of drugs to treat chemical agents, a plan for delivery and purchase of antibiotics, a hospital plan, a media plan, a mental health plan, and purchase of WMD equipment for law enforcement personnel. 

Hospital decontamination zone—This zone includes any areas where the type and the quantity of hazardous substance are unknown and where contaminated victims, contaminated equipment, or contaminated waste may be present. It can be anticipated that employees in this zone might have exposure to contaminated victims, their belongings, equipment, or waste. This zone includes, but is not limited to, places where initial triage and/or medical stabilization of possibly contaminated victims occur, predecontamination waiting (staging) areas for victims, the actual decontamination area, and the postdecontamination victim s inspection area. This area will typically end at the emergency department door. In other documents, this zone is sometimes called the warm zone, contamination reduction zone, yellow zone, or limited access zone. 

Hospital decontamination zone a zone that includes any areas where the type and quantity of hazardous substance are unknown and where contaminated victims, contaminated equipment, or contaminated waste may be present this zone is sometimes called the warm zone, contamination reduction zone, yellow zone, or limited access zone... 

After the victim has been transported to the hospital the ambulance vehicle must be decontaminated by trained personnel. 

In hospitals today a wide variety of complex equipment is used in the course of patient treatment. Humidifiers, incubators, ventilators, resuscitators and other apparatus require proper maintenance and decontamination after use. Chemical disinfectants used for this purpose have in the past through misuse become contaminated with opportunist pathogens, such as Ps. aeruginosa, and ironically have contributed to, rather than reduced, the spread of cross-infection in hospital patients. Disinfectants should only be used for their intended purpose and directions for use must be followed at all times. 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

Mobile Medical units with Clinic for First aid treatment Laboratory Diagnostic units operating theater hospital, specifications for treatment of patients affected by chemical agents (indication, decontamination). 

In addition to the modular storage equipment offered by States Parties, there are heavy equipment items such as decontamination systems, mobile laboratories, field hospitals, medical equipment, and facilities for the temporary accommodation of persons. Protection equipment for the team will also be put into modules to facilitate storage, handling, and transport. 

Improvement Item Mass casualty plan was not implemented initially due to communication difficulties. Communication of patient status at decontamination was not well-coordinated with Red Cross shelter representatives. Persons at shelters were registered, but if they were sent to the hospital or left with friends/family, their status was unknown. 

Hospitals should be notified immediately that contaminated victims of an attack may arrive or present themselves at a hospital whether or not they have been decontaminated, or not. 

Hazardous Materials Response Team(s) Establish the HazMat Group, and Provide Technical information/Assistance to Command, EMS Providers, Hospitals, and Law Enforcement. Detect/Monitor to Identify the Agent, Determine Concentrations and Ensure Proper Control Zones. Continually Reassess Control Zones, Enter the Hot Zone (with chemical personal protective clothing) to Perform Rescue, Product Information, and Reconnaissance. Product Control/Mitigation may be implemented in Conjunction with Expert Technical Guidance. Improve Hazardous Environments Ventilation, Control HVAC, Control Utilities. Implement a Technical Decontamination Corridor for Hazardous Materials Response Team (HMRT) Personnel. Coordinate and Assist with Mass Decontamination. Provide Specialized Equipment as Necessary. Assist Law Enforcement Personnel with Evidence Preservation/Collection, Decontamination. 

Medical Management Immediate decontamination after exposure is the only way to prevent damage to victims, followed by symptomatic management of lesions. Hospital care tends to be supportive. It should be repeated that liquid arsenical vesicants produce more serious lesions on dermal surfaces than do liquid mustard. In toxic victims, liberal fluids by mouth or intravenous, and high-vitamin, high-protein, high-carbohydrate diets could be indicated. For those victims where shock is in evidence, provide the usual supportive measures such as intravenous administration, blood transfusions, or other vascular volume expanders should be indicated. 

Decontamination immediately after exposure is the only way to present damage, with symptomatic management of lesion/blisters thereafter. All victims and first responders shall be decontaminated when leaving the Hot Zone. Clothes should be removed if at all possible, and no one should be transported to a hospital until he of she has been thoroughly decontaminated. Care in a hospital is strictly supportive. First responders have to ensure that every one contaminated goes through an efficient decontamination procedure. 

Individuals who have only received external contamination and are not otherwise injured should preferably be decontaminated at a location other than a hospital. 

The possibility of contamination may be determined in the field, en route to a treatment facility, or at the treatment facility, depending on the condition of the patient. Individuals subjected only to external contamination and not otherwise injured should be decontaminated (see Section 7.3) at a location other than a hospital. Patients who show no evidence of external contamination but have likely received... 

Treatment should be guided by the local or hospital resistance patterns. Extensive use of a quinolone for selective decontamination will increase the incidence of quinolone-resistant gram-negative pathogens. Alternative regimens for gut decontamination are oral colistin with an oral aminoglycoside such as neomycin. 

The use of FarGALS in the treatment of wound infections caused by polyresis-tant hospital microorganisms resulted in profound clinical improvement, as the wounds treated with FarGALS showed decreased exudation and increased decontamination rates by 2nd-3rdday of treatment, whereas in the control group the same effects were achieved by the 5th-6th day. 

While several trials demonstrated efficacy of such interventions in reducing the incidence of pneumonia, no convincing impact on mortality or length of hospital stay was demonstrated. In fact, the implications of these practices for development of antimicrobial resistance are so great that selective decontamination is not favoured and is, generally, not practised. 

Phenolic disinfectants are used for hard surface decontamination in hospitals and laboratories, eg, floors, beds, and counter or bench tops. They are not recommended for use in nurseries and especially in bassinets, where their use has been associated with hyperbilirubinemia. Use of hexachlorophene as a skin disinfectant has caused cerebral edema and convulsions in premature infants and occasionally in adults. 

Of the overall chemical bum patients, the most common sites involved were the face, neck, and upper body (87%), and the eyes or eyelids were involved in 19% of overall cases [28]. In deliberate chemical assault victims, the face and neck were commonly injured, but the genital area was also involved in many victims. Acids, such as sulfuric acid, can be obtained at low cost in Jamaica. These authors note that many of the chemical assault injuries were devastating with facial destruction and blindness. Less than half of the victims decontaminated tliemselves with copious water inigation before presenting to hospital [28]. 

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